THE JOURNAL OF PROSTHETIC DENTISTRY

LIVADITIS

The matrix impression system for fixed prosthodontics

Gus J. Livaditis, DDSa Baltimore College of Dental Surgery, Dental School, University of Maryland, Baltimore, Md.
This article describes the instrumentation, materials, and clinical procedures for the matrix impression system. The matrix impression system uses a custom matrix to control the sulcular environment and to deliver impression material to the subgingival parts to be impressed. It describes the four types of forces involved in gingival displacement during impressions, effective delivery of impression material with simultaneous sulcular cleansing, and simplification of complex impressions with or without segmentation. The application of the matrix impression system is described for making routine impressions and for some atypical problems. The article also provides a detailed description of the formation and design of the matrix. (J Prosthet Dent 1998;79:208-16.)

new fixed prosthodontic impression procedure is described that incorporates the attributes of traditional methods and overcomes important deficiencies in: (1) registration of subgingival margins, (2) gingival retraction and relapse, (3) hemostasis and sulcular cleansing, (4) delivery of impression material subgingivally, (5) strengthening the sulcular flange of the impression, and (6) simplification for making complex impressions. Successful subgingival impressions depend on effective management of the sulcular environment in two key aspects: the forces that come to bear on the gingival tissues and contaminants that may be present or generated in the sulcus. Four forces that must be controlled when making subgingival impressions are retraction forces, displacement forces, collapsing forces, and relapsing forces.

RETRACTION FORCES
Retraction forces are created by mechanical or chemomechanical procedures to release or displace the gingiva away from the prepared teeth and are usually applied before making the impression except for tube/coping impressions. Tube/coping procedures achieve and maintain retraction during the setting of the impression material by the sulcular extension of the copper tube or resin coping. However, in cord retraction procedures, the gingiva begins to relapse immediately on removal of the cord and continues to do so during seating of the impression tray and until polymerization of the impression material occurs. The Matrix Impression System (MIS) maintains retraction by trapping a highly viscous material in the sulcus when the matrix is fully seated. The distinguishing clinical value of the MIS is that it controls the displacement, collapsing, and relapsing forces.

Fig. 1. Matrix (A) is fully seated as seen by contact of untrimmed occlusal area. Matrix impression material (B) extrudes out displacing air and fluid contaminants from sulcus. Tray impression material (C) picks up matrix and also registers remaining natural teeth. Tray material has little impact on critical sulcular environment. Note relations of matrix to gingival crest.

from the prepared teeth. At the beginning of seating the filled matrix, the impression material flows over the prepared teeth and is directed toward the sulcus. At the final 1 or 2 mm of matrix seating, the highly viscous impression material in the matrix is driven with gentle force directly into the sulcus (Fig. 1). The extrusion of the excess material out of the sulcus causes lateral displacement of the gingiva until complete seating of the matrix occurs.

COLLAPSING FORCES
Collapsing forces are also generated by the impression procedure. Retracted gingival tissue is unsupported once the cord is removed. Typically, the tray impression material contacts the gingiva and collapses the tissue against the prepared tooth. Tube/coping procedures prevent collapse of the gingiva against the preparation
VOLUME 79 NUMBER 2

DISPLACEMENT FORCES
Displacement forces are those forces generated by the impression procedure directing the gingival tissue away
a

Clinical Associate Professor, Department of Restorative Dentistry. THE JOURNAL OF PROSTHETIC DENTISTRY

208

LIVADITIS

THE JOURNAL OF PROSTHETIC DENTISTRY

margins by the sulcular extension of the tube or coping. Tray/syringe procedures reduce the collapse by introducing material into the sulcus before seating the tray material. Wash/reline impression procedures provide no inhibition to collapsing forces, because nothing is in the sulcus when the tray material initially contacts the gingiva. The effect of collapsing forces on the success of making acceptable impressions has been ignored as they affect both tray/syringe and wash/reline impression procedures. The use of light-bodied impression material in the sulcus with heavier bodied material in the tray and the preference of closely adapted custom trays over stock trays contribute to increasing collapsing forces. The MIS reduces collapsing forces because low viscosity tray material in a spacious stock tray is resisted by the trapped higher viscosity sulcular material. In situations where sulcular material is allowed to fully polymerize before the loaded stock tray is seated, any potential collapsing force is completely prevented.

Matrix-forming material On setting, this impression material needs to provide a semirigid matrix. The feature described as semirigid is important. Several materials have the optimal level of rigidity while providing favorable trimming properties. A polyether occlusal registration material (Ramitec, Espe-America, Norristown, N.J.) and numerous polyvinyl siloxane (PVS) occlusal registration materials serve well in the formation of the matrix. More rigid materials such as those used for interim restorations and copings for impressions, as described by Cannistraci1 and LaForgia,2,3 would create difficulties when applied to nonparallel abutments, would be difficult to remove, and could result in fracturing of dies in the working cast on separation. The problem of dimensional instability confronted with methyl methacrylate resin copings4 is resolved by the superior stability of polyether and PVS materials. In contrast, a highly elastic or resilient material is difficult to trim, would distort easily during seating, and could be deformed on removal as a result of the elastic memory. The matrix-forming material should register details equal to the best impression materials. Putty-type materials have favorable characteristics in their polymerized state but, in my experience, do not have the flow characteristics to optimally register the sulcular portion of the arch. The matrix-forming material should be rapid setting and compatible with the matrix impression and tray impression materials. Ideally, it should bond with the other two materials without the use of an intermediate adhesive layer. Many paired materials will bond at the time of contact when both are unpolymerized. However, many of these same materials will not create a strong bond when the unpolymerized material comes into contact with the polymerized component. Substantial forces are generated on removal and delamination within the matrix has been observed with several combinations of materials. I have found a polyether adhesive (EspeAmerica) to be most effective for nonbonding pairs of materials. Several investigators,5-7 with the notable exception of MacSween and Price,8 have shown the polyether adhesive to provide good adhesion of impression material to trays. Little work has been done, however, to evaluate adhesives when they are used to join one impression material to another prepolymerized material. Matrix impression material This material is used to fill the matrix and generate the critical portion of the impression. It should be a high viscosity material to facilitate displacement of the gingival tissue and to effectively flush debris out of the sulcus. In my experience, high viscosity polyether (Permadyne, Espe-America) provides the highest viscosity available with the necessary elasticity and is the best for this purpose.
209

RELAPSING FORCES
Relapsing forces are inherent in the gingival tissue, causing it to return to its original position against the teeth. They may range from a gentle rebound of the gingiva to a moderately forceful expansion of gingiva that was compressed against adjacent teeth by the retraction cord. With the MIS, the flow of the viscous impression material into the sulcus resists mild relapsing forces. When the seated matrix closes off the escape way, the viscous impression material is trapped in the sulcus and resists the stronger relapsing forces. In my experience, this has been especially evident in proximal portions of adjacent prepared teeth. In these spaces, any displacement of the gingival tissue away from one preparation compromises the retraction of the soft tissue on the adjacent prepared tooth. Relief of the matrix in the embrasure allows balanced displacement of the gingiva. Because impression material is extruded into the sulcus around each tooth simultaneously and with equal force, the interdental papilla and septum should be guided to the midpoint to allow optimal registration of both teeth. The purpose of this article is to describe the clinical procedures for the Matrix Impression System and apply them to a variety of clinical situations.

MATERIAL AND METHODS

The MIS uses three impression materials: (1) a suitable elastomeric semirigid material required to form the matrix; (2) a high viscosity elastomeric impression material, which will preferably bond to the matrix-forming material, required to make an impression of the preparations in the matrix; and (3) a stock tray with a medium viscosity elastomeric impression material to pickup the matrix impression and the remaining arch not covered by the matrix.
FEBRUARY 1998

THE JOURNAL OF PROSTHETIC DENTISTRY

LIVADITIS

Fig. 2. Maxillary anterior teeth prepared for full crowns.

Fig. 4. Matrix is made in carrier with polyvinyl siloxane material before soft tissue is retracted. Registration of gingival crest is primary objective. Tissue under planned pontics and precision attachments should be included.

Fig. 3. Clear plastic carrier selected from assortment of premade forms. Carrier may also be made of wax.

Tray impression material The impression material that is placed in the stock tray should be compatible with and bond to the matrixforming material and the impression material lining the matrix. The viscosity of the tray material should be considerably less than the matrix material to facilitate impression removal. The traditional medium body elastomeric impression materials are ideal for the tray portion. Because the matrix manages the critical portion of the impression, a stock tray is used to incorporate the matrix and remaining teeth in the arch.9

Fig. 5. Facial and palatal sides of matrix are trimmed with scalpel. Matrix should extend one half to two thirds of tooth beyond prepared teeth and close to gingival crest. Black lines indicate sulcular extension.

CLINICAL PROCEDURES
Forming the matrix 1. Immediately after tooth preparation and before any retraction procedures (Fig. 2), select or create a carrier for the matrix forming material. (The carrier may be a manufactured product, premade in various shapes and sizes in the office with vacuum-forming equipment (Fig. 3), or may be made with wax
210

directly in the mouth. The carrier should provide 3 to 4 mm of space between its walls and the prepared teeth and 2 to 3 mm between its walls and adjacent unprepared teeth. It should extend one tooth beyond the prepared teeth on both sides when teeth are present. It should also extend 2 to 3 mm onto the ridge beyond the margin of the gingiva. All soft tissues under planned pontics and precision attachments should be included within the matrix carrier.) 2. Fill the carrier with Ramitec or PVS occlusal registration material and position it over the prepared teeth (Fig. 4). The carrier should be held to create a 1 to 2 mm thick occlusal wall over the unprepared teeth.
VOLUME 79 NUMBER 2

LIVADITIS

THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 6. Part of matrix has been colored to indicate important structures. Thin black line around each preparation identifies sulcular extension but not necessarily finish line of preparation. Thick red line indicates crest of gingiva. Two black marks point out proximal contacts that must be relieved.

Fig. 7. Slender bur or knife edged rubber wheel used to enlarge interproximal embrasures. This permits lateral displacement of gingiva when impression material is guided into sulcus.

3. After the material polymerizes, remove the impression from the mouth and separate the matrix from the carrier. Trim it with a scalpel, keeping one half to two thirds of a tooth beyond the prepared tooth or teeth to index the positioning of the matrix. Remove excess matrix material that extended onto the facial and lingual portions (Fig. 5). (The final matrix should delineate the occlusal surface and axial walls of the preparations and the crest of the gingival tissue because gingival retraction has not been implemented. The crevice between the prepared tooth surfaces and the gingival tissue should also be discernible. When this crevice is not registered in the matrix or if large voids have occurred, the matrix should be remade. Unlike many tube/coping impression techniques,2-4 it is not important to register the finish lines at this time. It is the crest of the gingival tissue that should be targeted.) If the impression of the preparations is to be made on a later visit, label the matrix and set it aside for trimming. When the impression is to be made during the preparation visit, proceed with refining the matrix. Refining the matrix The refinement of the matrix is easily accomplished by the dentist or auxiliary. The objectives in preparing the matrix, however, are specific and crucial to the success of the impression. The matrix should encompass the portions of the arch that are critical for a fixed prosthodontic impression, which include: (1) the prepared abutments, (2) the free gingival margin, (3) the marginal ridges and proximal surfaces of adjacent unprepared teeth, and (4) soft tissue portions under planned pontics and precision attachments. The other teeth and structures in the arch are relevant but do not require the
FEBRUARY 1998

attention and specific procedures necessary for an accurate impression of the critical parts of the arch. These critical parts should be visualized throughout the matrix refinement phase. 1. Mark the facial side of the matrix to maintain proper orientation throughout the trimming and impression phase. (When the matrix is a short segment as for single crowns, familiar landmarks will be lost during the trimming process and the matrix may be inadvertently seated in a reversed position.) 2. Trim the outer aspect of the matrix extending onto the ridge to remove all material that overlaps the gingival tissue (Fig. 6). Scalpels and straight handpiece aluminum oxide abrasive stones (No. 6 Faskut, Dentsply Int., York, Pa.) are effective. The angle of trimming is not critical, but the thickness of the matrix should be maintained between 1 and 3 mm. The outer portion of the matrix is trimmed to the gingival crest. Identify the crest of the gingiva and the sulcular extension, and mark them with a colored marker (Fig. 6). 3. Carve the interproximal areas between adjacent prepared teeth to create enlarged embrasure spaces for the interdental gingival tissue (Fig. 7). (The portion extending into the sulcus should be minimally carved so as not to weaken the sulcular extension. It is this sulcular extension that should ultimately direct the impression material deep into the sulcus [Figs. 7 through 9]. The enlarged embrasures should allow for controlled displacement of the proximal gingival tissue toward the center of the embrasure when impression material is guided into the sulcus.) At no time should the matrix trap the gingival tissue against the prepared tooth. 4. Relieve the portion of the matrix contacting the proximal surfaces of adjacent unprepared teeth to
211

THE JOURNAL OF PROSTHETIC DENTISTRY

LIVADITIS

Fig. 8. Mounted fast cut stone is used to relieve internal walls of each preparation 0.25 to 0.50 mm. Trimming of matrix is complete. Original marks in matrix on incisal surfaces are left intact.

Fig. 9. Matrix in place in mouth. Stock tray is selected to fit over matrix and any remaining teeth not covered with matrix. Relation of matrix to gingiva before retracted gingiva is depicted.

5.

6.

7.

8.

prevent wedging and distortion of the matrix at the time of seating (Figs. 6 and 8). (Failure to relieve these surfaces can result in tight proximal contacts and possible incomplete seating of the crowns. Although this can be corrected at the trial insertion visit for the crowns, prevention by relieving the proximal surfaces is preferred.) Trim the matrix on the axial walls of the prepared teeth to provide space for impression material and to create the path for the extrusion of impression material into the sulcus. The relief should be 0.25 to 0.75 mm (Figs. 1 and 8). (The relief on the proximal walls of adjacent prepared teeth may be reduced to the minimum dimension so that emphasis may be placed on external trimming for enlargement of the embrasure to allow gingival tissue displacement.) Do not trim the internal incisal or occlusal aspect of the matrix. These surfaces must serve as vertical stops (Fig. 1) to prevent seating the matrix beyond its original position and possibly creating distortion of the pliable matrix. Overseating of the matrix can result in wedging and lateral distortion. The matrix may rebound on removal, with the distortion becoming evident as undersized crowns. Abrade all external aspects of the matrix with the trimming stone to remove any glossy surfaces formed by the carrier and/or to remove any contamination by wax. The roughened texture will improve adherence of adhesives or impression materials. Mark the facial surface again to prevent confusion of the proper orientation once the matrix is filled with impression material. When the impression is to be delayed to another appointment, the matrix should be labeled with the patients name or number and stored in a clean environment.

Completing the impression This phase may be part of the preparation visit or a separate office visit. In the latter instance, the matrix is trimmed between visits. 1. Remove the interim restoration and clean the preparations. 2. Seat the refined matrix on the prepared teeth (Fig. 9) and select a stock tray to accommodate the matrix and other unprepared teeth. 3. When the matrix is made with PVS material, apply a thin layer of adhesive (Polyether Adhesive, EspeAmerica). (When polyether impression material is used for the matrix, the matrix impression, and the pick-up impression in the stock tray, no adhesive is required except on a nonperforated stock tray.) 4. Place retraction cord around each tooth leaving one end of each cord protruding 2 to 3 mm for easy retrieval. (Retraction cord [Gingi-Plain, 2-ply nonimpregnated, Gingi-Pak, Camarillo, Calif.] should be moist with hemostatic agent or water when being placed. A moist cord reduces the probability of bleeding when it is removed. Any blood present in the sulcus during retraction procedures should be rinsed clean. No blood should be allowed to dry on the preparations. The matrix system is designed to remove fluids from the prepared teeth and sulcus but no impression procedure will remove dried blood from prepared teeth.) 5. Mix high viscosity impression material (Permadyne, Espe-America) and load it in a conventional impression syringe. Dispense the material to fill the preparation depressions of the matrix (Fig. 10), then apply the material generously around all of the soft tissue side. (This should be done in a manner not to trap air in the occlusal recesses. Unlike other proceVOLUME 79 NUMBER 2

212

LIVADITIS

THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 10. Matrix is painted with polyether adhesive to generate more secure bond with nonbonding materials. Impression syringe is used to fill matrix with high viscosity impression material.

6.

7.

8.

9.

10.

dures,3 vent holes in the matrix should not be placed in an attempt to prevent air entrapment.) Remove all retraction cords. Optionally, additional material from the syringe may be dispensed around the prepared teeth. It is not essential to direct this material into the sulcus because that objective will be accomplished by the matrix. (The additional material pushed ahead of the matrix serves to flush out debris from the sulcus. This step is considered to be more valuable when the prepared teeth are small in dimension and less material is available within the matrix.) Seat the filled matrix on the prepared teeth with the adjacent teeth and structures for orientation (Fig. 11). Excessive force should not be applied. (When properly designed, the matrix has a definitive seat as provided by the vertical stops.) A vertically directed force should be applied with light finger pressure. Final seating is easily discernible to the operator. Immediately make a mix of medium viscosity impression material (Impregum F, Espe-America), load the stock tray, and seat the tray over the matrix impression. (The relative viscosity of the two impression materials is the reverse of traditional procedures.) After the impression materials have completely polymerized, remove the impression and examine it for defects. The matrix is often visible through the matrix impression material (Fig. 12). This is acceptable because the matrix was formed with a quality impression material and becomes integrated into the impression. When the impression is acceptable, form the master cast according to a desired procedure.

Fig. 11. Matrix impression is seated with light pressure. Axial walls and positive vertical stops make proper seating easily discernible. Mark may be placed on facial surface for proper orientation, because many references are covered with impression material. Stock tray filled with medium viscosity impression material is seated over matrix impression before matrix material polymerizes.

Fig. 12. Completed impression shows registration of preparation margins. Quality and thickness of sulcular flange due to effective gingival displacement. Matrix visible through impression material in places is acceptable because it becomes integrated part of impression.

SPECIAL PROCEDURES
Matrix design for finish lines in a deep sulcus When finish lines are more than 1.0 mm subgingival as in fractured teeth, the gingiva tends to collapse against
FEBRUARY 1998

the preparation. The matrix should be formed with a greater extension into the sulcus (Fig. 13). In these situations, the matrix must provide some retraction as well as deliver impression material during the actual impression. The matrix should be formed at the crown preparation visit when the deeper crown margin is exposed or after the interim crown is removed (Fig. 14). A properly formed interim crown is essential to maintain the normal space between the gingival tissue and the crown preparation. Additional procedures may be required to extend the matrix into the deeper sulcus. For example,
213

THE JOURNAL OF PROSTHETIC DENTISTRY

LIVADITIS

Fig. 13. Fracture of cusp resulted in margin of preparation being deep under gingival crest. Crown lengthening was not option. Matrix extended well into sulcus without retraction.

Fig. 15. Isolated teeth require special considerations for seating and orientation of matrix impression to compensate for loss of stabilization provided by adjacent teeth. Matrix is designed to extend 10 to 5 mm onto adjacent soft tissue ridge and is trimmed to permit displacement of sulcus while maintaining some of ridge tissue intact for orientation.

Matrix design for isolated abutments When a single abutment exists in a large edentulous space, the resultant matrix has few references for proper orientation and seating. The internal aspect is trimmed in the usual manner to maintain a positive vertical stop for the matrix by not trimming the internal occlusal or incisal portion. Unlike more typical situations, the matrix should extend well onto the edentulous ridge, approximately 10 to 5 mm. The matrix covering the soft tissue around the perimeter of the abutment is trimmed to allow the usual gingival displacement (Fig. 15). The additional ridge portions are left intact to assist in the orientation of the matrix. Soft tissues serve poorly as vertical stops, but they are effective in preventing undesirable rotation of the matrix (Fig. 16). Segmented matrix impressions In this author's experience, conventional bilateral impressions systems are more difficult because of the need for isolation of the teeth and retraction of the lips, cheeks, and tongue. The matrix system allows the segmentation of complex impressions into more manageable sections while still providing a full arch impression. Typically, when a few closely positioned prepared teeth exist, a single matrix, including all prepared teeth, may be used. The matrix procedure provides time to remove the cord, insert the matrix, and seat the full arch tray well within the working time of the impression material. When prepared teeth are separated by several intact teeth or long edentulous spaces, the prepared teeth may be divided into two or more segments and a matrix impression made of each segment. In this situation, the first matrix is seated taking care to remove excess imVOLUME 79 NUMBER 2

Fig. 14. Matrix system impression facilitates registration of deep margins by effective sulcular cleansing while simultaneously delivering impression material into deep sulcus.

matrix-forming material may be syringed into the deep sulcus immediately before seating the matrix-forming carrier. The extended matrix will deliver the impression material in the deep sulcus. The need for this approach is rare and usually limited to fractured teeth where crown lengthening procedures cannot be applied. These are difficult impressions with any procedure. The matrix system should allow for more predictable results.
214

LIVADITIS

THE JOURNAL OF PROSTHETIC DENTISTRY

pression material that may interfere with seating of the full arch impression tray. The first matrix impression is allowed to polymerize, after which the final matrix impression is prepared. With another mix of high viscosity impression material, the final matrix is loaded and positioned. The full arch tray is immediately seated to capture both matrix sections simultaneously. The completed impression is no different than if both matrix segments were seated simultaneously. The last matrix and the loaded tray should not be seated during the polymerization phase of the first matrix. The initial matrix impression should be allowed to fully polymerize to prevent distortion. If segmentation is preferred, the matrix may be formed initially in segments or the larger matrix may be sectioned during the refinement phase. The segments should terminate in edentulous areas or over intact teeth but not between adjacent prepared teeth. Ample space should be provided between them to prevent one segment from interfering with seating of subsequent matrix segments. The material in the stock tray will ultimately connect the segments. Segmentation allows the operator to reduce the complexity of a traditionally difficult impression to a very manageable level. This feature is more valuable on the mandibular arch where control of the environment is more difficult. Although more time is required as the number of prepared teeth increases, the complexity of making the impression does not increase substantially. The procedure of allowing the matrix impression segment to fully polymerize before seating the tray is also advantageous when managing short or isolated prepared teeth. Typically, the seated matrix demonstrates a positive and stable position as a result of the contact with the prepared surfaces and the adjacent teeth. There is little concern that the matrix may be displaced when seating the stock tray. In the absence of adjacent teeth or when dealing with short clinical crowns, the trimmed matrix may not demonstrate the same level of stability. If the matrix impression is allowed to fully polymerize, potential displacement by the seating of the stock tray is essentially prevented.

Fig. 16. Untrimmed incisal portion in matrix provides vertical stop and soft tissue ridge portion prevents rotation of matrix when impression is made.

This system may appear to resemble a modified version of a wash type impression. With the exception of the hydrodynamic impression technique described by Lococo,10 I question whether relined or wash impressions effectively direct the flow of impression material into the sulcus. As the full arch tray is seated in wash procedures, it would appear that the tray impression material could trap and collapse the gingival tissue against the prepared teeth. When the tray is partially seated, there does not appear to be any escape for air or fluids trapped in the sulcus. The trapped air or fluids can translate into voids in the set impression. The matrix appears to direct the flow into the sulcus and force out air and fluids (Fig. 1). The excess material in the matrix could then cleanse the tooth surface and sulcus as it extrudes out in a manner similar to the tube/coping system. This is supported by the frequent observation that blood from the sulcus is displaced several millimeters from the sulcus onto noncritical vestibular or palatal portions while the tooth surfaces are free of any blood.

SUMMARY
The matrix impression system is introduced that incorporates features of the three basic categories of impression systems but that has its conceptual origin in the autopolymerizing resin technique for interim fixed restorations. The new method can significantly improve the gingival displacement and sulcular cleansing phases. The matrix has resolved the problems of gingival bleeding and other sulcular contaminants and virtually eliminated tearing of the sulcular flange. The matrix impression system has reduced complex fixed prosthodontic impressions into simpler component matrix impressions. The use of a precisely designed matrix can provide a means to better control the unpredictable dentogingival environment when making impressions.
215

DISCUSSION
The traditional impression syringe enables the extrusion of impression material into the sulcus more effectively than putty/wash techniques. With multiple abutments, this requires a precise, gentle, and swift movement of the syringe around each sulcus. However, with the MIS, the matrix dispenses the impression material into the sulcus (1) with greater precision and consistency than a syringe, (2) with a gentle but controlled force, and (3) simultaneously into all sulcular parts. It markedly reduces the time required to cover all exposed surfaces of the prepared teeth to permit the use of impression materials with shorter working time.
FEBRUARY 1998

THE JOURNAL OF PROSTHETIC DENTISTRY REFERENCES

1. Cannistraci AJ. A new approach to impression taking for crown and bridge. Dent Clin North Am 1965;9:33-42. 2. LaForgia A. Cordless tissue retraction for impressions for fixed prosthesis. J Prosthet Dent 1967;17:379-86. 3. LaForgia A. Multiple abutment impressions using vacuum adapted temporary splints. J Prosthet Dent 1970;23:44-50. 4. Hoffman JM. Nontraumatic final impressions for fixed partial dentures. J Prosthodont 1992;1:61-4. 5. Grant BE, Tjan AH. Tensile and peel bond strengths of tray adhesives. J Prosthet Dent 1988;59:165-8. 6. Samman JM, Fletcher A. A study of impression tray adhesives. Quintessence Int 1985;16:305-9. 7. Chai JY, Jameson LM, Moser JB, Hesby RA. Adhesive properties of several impression material systems: part I. J Prosthet Dent 1991;66:201-9. 8. MacSween R, Price RB. Peel bond strength of five impression tray adhesives. J Can Dent Assoc 1991;57:564-7.

LIVADITIS

9. Livaditis GJ. Comparison of the new matrix system with traditional fixed prosthodontic impression procedures. J Prosthet Dent [in press]. 10. Lococo MP. The hydrodynamic impression technique. J Can Dent Assoc 1986;52:10001-3. Reprint requests to: DR. GUS J. LIVADITIS 1206 YORK RD. SUITE 100 LUTHERVILLE, MD 21093-6243 Copyright 1998 by The Editorial Council of The Journal of Prosthetic Dentistry. 0022-3913/98/$5.00 + 0. 10/1/85863

216

VOLUME 79 NUMBER 2